Adverse cardiovascular disease outcomes in patients with aortic sclerosis and mitral annular calcification even when valve function is normal

The severity of stenosis or regurgitation, the presence of symptoms and the consequences on the left ventricle are the main drivers of decision-making for the management of valvular diseases in current guidelines.1 2 Interventions are generally considered in severe valvular diseases and most publications focus therefore on severe lesions, although more attention is now paid on moderate valvular disease, in particular regarding aortic stenosis. The originality of the paper by Taylor et al 3 is to also analyse the prognostic impact of the least severe valvular heart disease, that is, mild valvular disease, as well as calcific valve lesions without functional effect on the same valve, that is, aortic sclerosis and mitral annular calcification (MAC). Separating functional and anatomical valvular lesions is challenging since there is a close interaction between valve function and anatomy. As an illustration, the quantification of calcium burden using the calcium score is now recommended to assess aortic stenosis severity, which is complementary to echocardiography.1 2 Nevertheless, the definitions used in the paper by Taylor et al allow for separate assessment of the prognostic impact of the severity of valvular disease and of the extent of calcific valve lesion. Mild valvular disease and anatomical lesions without functional consequences can be studied only by using systematic echocardiographic screening, which is an important feature of the OxValve cohort. Although this is not current recommended practice, a reliable detection of valvular disease requires systematic echocardiography, with only 10% of valvular disease detected by cardiac auscultation. This is particularly true for mild valvular disease and calcific valve lesions, which are …